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104 Cards in this Set

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ideal psy drug should act directly on the --- mechanish of the ----- or ------ to cure or alleviate
pathogenetic

symptom

disorder

(but it's unknown)
ideal psy drug should be effective -----
rapidly

sometimes not effective and rapid
ideal psy drug should benefit most or all pts for who it's indicated
only works on 70% for antipsy

and 50% for antidepressants
ideal psy drug should not allow --- to develop

show be ----- and lack potential for creating -----
tolerance

nonhabituating

dependence

have increased tolerance and addiction
ideal psy drugs should have min ----- in the tx range and have low incidence of 2ndary ----
toxicity

se
ideal psy drugs should not be ---- in overdose and be adaptable in both--- and ----
lethal

inpatients

outpatients
ideal psy drugs should not impaire any ---, ---, or --- fxs
cognitive

perceptual

motor
which drugs have the most se
MAOI

TCA

TAP
which drugs have the least SE
SSRI

NSRI

NSSRI

ATAP
dx of schizophrenia:

at least 1 ---- symptom plus - or more of the other symptoms
positive

1
how long must you have the symptom to be dxed w/ schizophrenia
over 6 months
dx of schizophrenia involoves no evidence of --- or --- disorder
drug induced

mood
positive symptoms
hallucinations

delusiions

disorganizede speech/formal thought disorder

disorganized/bizarre/catatonic behavior
neg symptoms
alogia

avolition/amotivational

affective blunting

anhedonia
cognitive defects symptoms
tangentiality

incoherance

looseness of associations

neologisms
domain of diorganized/bizarre/catatonic behavior
positive symptoms
domain of disorgainzed speech/formal thought disorder
positive
DA hypothesis of psy disorders

too much DA in the -------
mesolimbic

from NAC to VTA
da hypothesis of psy disorders

too little DA in the ---- systme
mesocortico system

vta to frontal cortex
too little da inthe mesocortical system can lead to --- symtoms
mesocortico
sertonin hypothesis:

too much/little 5HT inhibiting ---- cortex
too much 5ht

prefrontal

this leads to an imbalance in DA
glutamate hypothesis:

loss of --- receptors
NMDA
neurodevelopment hypothesis:

abnormal --- development

involved w/ neuronal ------ and ----
feta

migration

connection
pts lacking connections tend to have --- ventricles
larger
pt's might have neuro----
neurodegeneration
why do meds take a while to tx psy
cuz need to reconnect
the mesolimbic is the --- --- area to the --- ----, ----
ventral tegmental area

nucleus accumbens

amygdala
the mesolimbic is involved in ----, --- psychosis
addiction

amphetamine
if the mesolimbic becomes hyperfunctional what occurs
pos symptoms
mesocortical is the --- ---- area to the --- ---
ventral tagmental area

frontal cortex
mesocortical execute functio fothe brain due to --- feedback to Nac
inhibitory
mesocortical pathway may become hypofunctional which may lead to ----
neg symptoms
where the motor control
nigrostriatal pathway
nigrostriatal pathway is the basis of ------ se
motor-related
what's involved in endocrine fx
tuberoinfundibular

tuberhypophyseal
the tuberoinfundibular and tuberohypophyseal are the basis for ---- related SE
prolactin
what usu inhibits prolactin
DA

so when blocked. .. increas in prolactin
what can an increase in prolactin cause
menstrual irregularities

gynecomastia
ctz is located in the --- ---
area posterna
t/f

block da can lead to emesis
f

antiemetic effects
how to avoid eps
slowly taper after 1 yr
drug tx works best for ---- episodes of --- symptoms
acute

positive
which eps irreversible
tardive dyskinesia
the sedative action and the cognitive dysfunctions due to
anticholinergic

antihistminic effects
if you block the 5HTA/C receptor what occurs
inhibitor of DA. . . less DA
high potency meds will have what type of se
parkinson's

cuz higher affinity for DA
the low potency meds wil lhave have what type of SE
muscarinic

adrenergic

histiminic

other SE
normal there's a balance btw DA and --- that prevents parkinson's
muscarinic

so when you decrease and the higher muscarinic will lead to parkinson se

you'll also have to block the muscarinic to to restore balance
w/ D2 like receptor subtype antagonism you decrease --- symptoms via decrease NAC DA signaling
positive
w/ D2 like receptor subtype antagonism you decrease positive symptoms via decrease --- DA signaling
NAC
how will the neg symptoms worsen
by decreaseing PFC signaling
se due to antagonism of d2-like

intially there's --------
parkinson like symtoms
d2 like antag leads to --- --- w/ prolonged tx
tardive dyskinesia
d2 like antag can lead to gyencomastia due to increased ---- due to -- blockade
prolactin

D2
alpha-1 antag can lead to these se
dizziness

postural hypotension

relfex tachycardia
antimuscarinic can lead to


--- vision

--- mouth

constipation

--- retention
blurry

dry

urinary
antimuscarinic can relieve/worsen intital parkinsonism, relieve/worsen tardive dyskinesia
relieve

worksen
what can lead to sedation and weight gain
blocakge of histamine receptors
too much antagonist can lead to an ---- of receptors
upregulation
too much antagonist can also lead to

-----in 2nd messengers

---- metabolism of Da

----synthesis/release of DA
increase

decrease

increase
major limiting factor for tx use of antipsychotics
eps
parkinson' like se
catatonia

motor rigiditiy

tremor
which 5HT leads to weight gain
combo of 2A and 2C
dystonia can lead to --- muscle contractions that cause ----- and uncontrolled movements of the face, neck and -----
involuntary

bizarre

tongue
severe restlessness and agitation
akathisia
when are movement continuous for tardive dyskinesia
during waking hrs
who's more prone to tardive dyskinsia

men or women
women
how long can it take tardive dyskinesia to decrease
2-5 yrs
what can increase TD sensitivity
anticholinergics

L-dopa
s/s of TD
chewing

licking movements

tongue protrusions

limb movements
td possibly b/c:

continuous exposure to --- antagonist led to increased --- number or increased --- to DA
DA

receptor

sensitivity
another theory of td

some d2 receptors cause --- and --- while others cause parkinsonism
dyskinesias and dystonia

parkinsonism and akathisia
td can be due to decreased striatal -- acitivity
GABA
abnormal d2/d- ration can cause td
d1
d1 agonists cause more TD if --- receptors blocked
D2
---- ---- decrease dose until symptoms decrease
drug holidays

may return more severe even at lower dose
tx of td

--- or switch to an atypical antipsychotic
d/c

lower but not zero (switching)
what can help w/ reducing
cholinergic agonist
which receptors more specifically involved in eps
D2
atypical antipsychotics have -- to --- x less potent for --- and ---- se
eps

prolactin
atypical antipsychotics have more efficacy towards --- and -- symptoms
negative

cognitive
aytpical have less ---, ---- impairment, and ----
sedation

cognitive

catalepsy
atypical have less --- --- w/ prolonged use
td
se of atypical
weight gain

dm

increased cholesterol

heart probs
why less sedation w/ atypical
cuz they are more selective
possible mech of atypical

limbic or cortical D- and D- receptors vs ----- D2
D3 and D4


striatal
mech for atypical

blockade of --- ---- 5Ht-2 receptors
frontal cortex
blockade of frontal cortex 5HT receptors stops --- inhibition of mesocortical ----
Serotonin

dopamine

(decrease neg symptoms)
which se occurs mainly at d2 receptors
akathisia

eps
what % of D2 occupancy needed for tx w/ typical and atypical
typical: 70%

atypical: 20%
dose response separation btw --- and --- effects is possible mechanism of atypical
therapeutic

motor
atypical might need contribution from ---- occupancy
5HT2
se of atypical
weight gain

impaired glucose tolerance

hyperlipidemia
clozapine se
1% incidence of agranulocytosis

monitor wbc q week
ziprasidone, sertindole, and thioridazine se
qt prolongation and risk of sudden death

binds to K channel subtype
risperidone se
increased risk of stroke

some eps

gynecomastia
olanzapine se
increase risk of stroke

worst weight gain
aripiprazole se
increase risk of stroke
s/s of malignant syndrome
catatonia

stupor

fever

unstable bp

myglobinemia
mech of malignant unknown but r/t --- receptor antagonism
DA
tx of malignant syndrome
stop tx and give

dantrolene

bromocriptine
which will have more malignant syndrome
typical
bromocripitne have ---activity
agonist
partial agonist restore transmission needed but block where needed. ..
balance